Narratives of chronic pain from armed forces veterans
This PhD thesis explores the experiences of 14 veterans of the UK Armed Forces who live with chronic pain. While there is a wealth of data exploring chronic pain in Armed Forces veterans, the existing literature overwhelmingly views chronic pain through a quantitative lens which does not explore the depth of chronic pain lived experience as a result of this; therefore, it is unclear how veterans live with and manage their chronic pain. Participants' stories of living with chronic pain were collected and analysed using dialogical narrative analysis and the analytical lens of autobiographical time, to detail veterans’ autobiographical stories of living with chronic pain, and how they use these stories to make sense of their pain experience in the context of their identity as a veteran. The analysis identifies that the participants understood and made sense of their chronic pain experience through three distinct storytelling phases. The first of these were stories of the military body, and this situated a career that was marked by physicality and the churn of life within the military institution. The second phase of storytelling was about the stigmatised body. These stories situate the attitudes toward pain and weakness within the military and the consequences of showing that the military body is infallible, which in turn inform stoic attitudes toward pain and personal pain management. The final phases of storytelling were told about the moving body, stories about the moving body were about making sense of a new body with pain, how some movement is avoided, and the consequences of this on identity. And how movement is used to understand, learn, and respond to and from their bodies on any given day. This is the first in-depth qualitative study that explores the lived experiences of veterans with chronic pain. It found that stories about chronic pain were told in the context of military experience and how the culture of the military shapes attitudes toward chronic pain, while movement was a keyway in which participants live with and manage their chronic pain.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.